Kolb, N.A., Smith, A.G., Singleton, J.R., Beck, S.L., Howard, D., Dittus, K., . . . Mooney, K. (2018). Chemotherapy-related neuropathic symptom management: A randomized trial of an automated symptom-monitoring system paired with nurse practitioner follow-up. Supportive Care in Cancer, 26, 1607–1615.

To evaluate a nursing care model (automated symptom-monitoring and coaching system including NP follow-up of moderate to severe symptoms) to reduce CIPN symptoms.

Patients on taxane/platin therapies called an automated telephone symptom-monitoring system (SCH) daily to report symptoms of numbness and tingling. The system recorded severity, distress, and activity interference on a 0-10 scale. Patients in the telephone-monitoring group received automated self-care strategies and an NP-provided guideline-based care for symptoms rated as 4 or greater. Patients in the usual care group were instructed to call their oncologist for symptom management.

• N = 252 (238 completed the study)
• AGE: Mean age = 55.1 years (SD = 11.3)
• MALES: 51  (21.4%)
• FEMALES: 187 (78.6%)
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Treatment plan of a minimum three cycles of chemotherapy–any disease
• OTHER KEY SAMPLE CHARACTERISTICS: Must be receiving taxane- or platin-based chemotherapy

• SITE: Multi-site   
• SETTING TYPE: Outpatient    
• LOCATION: Utah and Vermont

PHASE OF CARE: Active anti-tumor treatment

Secondary sub-analysis of a randomized controlled trial

Symptom severity measured daily on a 1-10 scale with 10 being most severe. SF-36 and a detailed chemotherapy treatment data sheet were updated monthly. Secondary outcomes were distress associated with numbness and tingling, interference with activities of daily living, and helpfulness of self-care strategies–all scored on a 1-10 scale. Associated symptoms and use of other services were also measured.

The SCH group experienced significantly less symptoms of numbness and tingling and the number of days with neuropathic symptoms of any severity was lower in the SCH group (10.3 versus 17.8, p = 0.02). In addition, the SCH group had less moderate symptom days and less severe days (p < 0.001 and p = 0.006, respectively). Similar trend was seen in distress related to numbness and tingling. NPs called 3.2% of days in the SCH group. For the usual care group, despite 11% of days reporting symptoms 4 or greater, no participants called their HCP for symptom management.

This proactive symptom monitoring intervention was effective in monitoring and intervening for symptoms related to CIPN. Automated self-care strategies for all intervention patients and guideline-based intervention by an NP led to less moderate and severe symptom days in the intervention group. Despite reporting 11% of days with moderate or severe symptoms, no patients in the usual care group called their healthcare provider for symptom management.

• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (sample characteristics)
• Other limitations/explanation: Due to the large number of women with breast cancer, the study was predominately female which limits generalizability to men. Specific strategies patients used to manage symptoms were not collected.

Routine monitoring of symptoms using PROs can be completed in a variety of ways and is an actionable tool to improve patient outcomes. This study highlights that patients do not frequently call their HCP when experiencing symptoms and that a proactive approach using a phone-based automated symptom assessment intervention holds promise in symptom management.